Renal cell carcinoma (RCC) is the most common form of kidney cancer. About one-third of people with RCC have cancer that metastasizes (spreads to other organs).

Between 18 percent and 20 percent of people with metastatic RCC have cancer that has spread to the liver. Liver metastasis is more likely when the cancer has already spread to the lungs or bones.

Here’s what you need to know about kidney cancer and liver dysfunction, including symptoms to watch for and discuss with your doctor.

What Should You Know About Liver Metastasis?

When metastatic kidney cancer spreads to the liver, it can affect overall survival rates. It may also limit treatment options and raise the risk of the cancer coming back after treatment.

Outcomes

When cancer spreads to other parts of the body, survival rates go down. For example, the five-year survival rate is more than 90 percent when RCC is limited to the kidneys. That rate drops to 20 percent for metastatic RCC.

When RCC spreads to the liver, the median survival time is 17.6 months. Studies show that almost 42 percent of people with RCC and liver metastasis have cancer that returns after treatment. Recurrent cancer may affect the liver again or spread to other areas.

Treatment Options

Nephrectomy (surgery to remove part or all of a kidney) is a common treatment for RCC and may still be recommended even if the cancer has spread. In people with liver metastasis, nephrectomy may increase the five-year survival rate from 20 percent to between 38 percent and 62 percent.

It may not be possible to treat liver tumors directly with surgery or radiotherapy. Instead, doctors often use combination therapies. These may include immunotherapy, which helps the immune system target cancer cells throughout the body rather than in one area.

Treatment options continue to improve, but early detection is important for better outcomes.

How Does Liver Metastasis Affect Liver Function?

The liver is a common place for kidney and other types of cancer to spread. Liver metastasis may involve one tumor or several throughout the liver.

Doctors may find liver metastasis right away, at the same time they diagnose kidney cancer. In some cases, cancer spreads to the liver years later. Your healthcare provider can keep an eye on your liver function with blood tests during regular checkups.

Hepatic Encephalopathy

The liver is an essential organ with many jobs, including filtering toxins from the blood. Tumors can get in the way of the liver’s ability to function. When several tumors grow in the liver, or when tumors are located in key areas, liver function can become seriously affected.

Hepatic encephalopathy — a serious complication of poor liver function — occurs when toxins build up in the blood and affect the brain. This condition can cause confusion, sleepiness, and trouble thinking clearly. In severe cases, hepatic encephalopathy can lead to coma or death.

Learning to recognize early symptoms of liver problems may help you get treatment sooner and lower the risk of hepatic encephalopathy.

What Are the Symptoms of Liver Metastasis?

The symptoms of liver metastasis are similar to those of liver disease. They’re general signs that the liver may not be working well. Let your cancer care team know if you notice any of the following symptoms.

1. Itchy Skin

When the liver is damaged, certain chemicals can build up in the bloodstream. These substances may include hormones, histamine, and bile salts that irritate nerves in the skin and cause itching.

You may feel itchy all over or only in certain areas, such as the:

• Arms
• Palms of the hands
• Legs
• Soles of the feet

Itching may get worse as liver damage increases. What starts as a mild annoyance can grow into a persistent problem that keeps you up at night and disrupts daily activities.

Talk to your healthcare provider if you develop itchy skin. Scratching can damage the skin and increase the risk of infections or scarring.

Keeping your skin cool and moisturized may help. In some cases, your doctor may recommend medicated creams or other treatments to reduce the itch.

2. Swelling in the Legs and Belly

People with liver problems may retain extra fluid, which leads to swelling. This symptom is usually linked to portal hypertension — increased blood pressure in veins that carry blood to the liver.

Swelling can affect the legs (edema) and the abdomen (ascites). With ascites, the belly may become swollen, hard, or painful. Fluid buildup can also push the belly button outward.

Swollen areas are prone to infection. If you have edema or ascites along with fever or pain, seek medical care right away. These infections can also affect the kidneys and may become life-threatening if not treated.

3. Jaundice

Jaundice is a condition that causes the skin and the whites of the eyes to look yellow.

The body naturally breaks down red blood cells. This process produces a compound called bilirubin. Normally, the liver mixes bilirubin into bile fluid and sends it to the digestive system.

When the liver isn’t working properly, bilirubin can build up in the blood. Because bilirubin is yellow, high levels can make the skin and other tissues appear yellow.

4. Feeling Unwell

Some symptoms of liver metastasis are less specific. You may feel generally unwell, with symptoms like fatigue, poor appetite (which may lead to rapid weight loss), or fever.

It can be hard to know if these changes are caused by renal cell cancer, liver issues, or another illness such as a cold. Be sure to follow up with your healthcare provider so they can decide whether more testing is needed.

How Does Cancer Treatment Affect Liver Function?

In addition to liver metastasis, some kidney cancer treatments can also affect liver function. Certain chemotherapy, immunotherapy, and targeted therapy drugs are processed through the liver and may cause liver-related side effects.

If your treatment is known to cause liver damage, your healthcare provider may recommend extra fluids or other steps to reduce the risk of liver damage.

Radiation therapy can also affect the liver, especially when high doses are used or treatments are given often.

When Should You Contact Your Doctor?

Contact your oncology team if you develop pain or symptoms of liver problems. Your healthcare provider can use blood tests to monitor your liver function. If they suspect liver metastasis, they may order imaging tests such as a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan to look for tumors.

Getting medical care and support early on gives you the best chances of managing liver problems related to kidney cancer.

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